UC Irvine

Western Journal of Emergency Medicine: Integrating Emergency

Care with Population Health

Title
Impending Airway Compromise due to Cystic Hygroma

Permalink
https://escholarship.org/uc/item/17z5050z

Journal
Western Journal of Emergency Medicine: Integrating Emergency Care with Population
Health, 12(4)

ISSN
1936-9018

Authors
Weiser, Giora
Beck-Razi, Nira
Shavit, Itai

Publication Date
2011-01-01

DOI
10.5811/westjem.2011.2.2170

License
CC BY-NC 4.0

Peer reviewed

eScholarship.org Powered by the California Digital Library

University of California
 IMAGES IN EMERGENCY MEDICINE

Impending Airway Compromise due to Cystic Hygroma

Giora Weiser, MD* * Rambam Health Care Campus, Meyer Children’s Hospital, Rambam Health Care
Nira Beck-Razi, MD† Campus, Haifa, Israel
†
Itai Shavit, MD* Rambam Health Care Campus, Department of Medical Imaging, Haifa, Israel

Supervising Section Editor: Sean Henderson, MD

Submission history: Submitted January 1, 2011; Revision received January 14, 2011; Accepted February 7, 2011
Reprints available through open access at http://escholarship.org/uc/uciem_westjem
DOI: 10.5811/westjem.2011.2.2170

We report on a 3-month-old infant, who arrived in the pediatric emergency department (ED) with a
cervical cystic hygroma causing an impending compromise of the airway. We recognize that such a
lesion can rapidly progress, and the judicious use of imaging in the ED may help to avoid airway
compromise and possibly fatal complications. [West J Emerg Med. 2011;12(4):368–369.]

A 3-month-old boy, who was diagnosed after birth as
having a cystic hygroma, was referred to the emergency
department (ED) for further evaluation. The baby had no signs
of respiratory distress, but a large lesion was noticed on the
right neck, emerging from the base of the tongue and
threatening the airway patency (Figure 1). Ultrasound
examination revealed a large cystic lesion insinuating around
the normal structures of the neck on both sides without
compressing the airway (Figure 2). The patient was admitted
for further evaluation, and a prophylactic tracheotomy was
performed. Unfortunately, the baby died at home 2 months later
because of tracheotomy tube–related complications.
Lymphatic malformations are a group of vascular
malformations that are usually benign in their behavior. Cystic

Figure 1. A, Cystic hygroma on the right side of the neck. B, The lesion is infiltrating the oral cavity and displacing the tongue upward.

Western Journal of Emergency Medicine 368 Volume XII, NO. 4 : November 2011
Weiser et al
Figure 2. Sonographic longitudinal view of the right neck. A large
mass is seen (arrows), insinuating around the normal structures of
the neck. The mass is partially anechoic (cystic) and partially shows
mixed echogenicity with septae of variable thickness.
hygroma, the largest and most extensive lymphatic
malformation, is diagnosed at birth in 40% of the cases.1 Cystic
hygromas usually involve the head and neck, and their course is
indolent in most cases.1,2 However, these lesions may
hemorrhage, develop inflammation or infection, or may
progressively enlarge, leading to an expanding lesion that may
physically compress local organs.3 Surgical excision is
regarded as the treatment of choice; however, when radical
excision is surgically challenging, the patient will be treated
with sclerotherapy, an injection of a sclerosing substance such
as OK432 into the lesion.4,5 Sclerotherapy is problematic in
cases of airway compromise because of the additional edema
that may develop.4,5 Presentation of an emergency airway
compromise due to a cervical cystic hygroma is usually
uncommon, but the emergency physician must be aware that
any child with a large cystic lesion may have a massive
infiltrating hygroma with a much greater internal involvement
of local organs and tissues surrounding the larynx.6–8
Ultrasonography is a readily available technique in the ED, and
Volume XII, NO. 4 : November 2011
Impending Airway Compromise
we recommend using this modality to evaluate the
extensiveness of such a lesion.
Address for Correspondence: Itai Shavit, MD, Rambam Health
Care Campus, Meyer Children’s Hospital, Department of
Emergency Medicine, 6 Ha’Aliya St, PO Box 9602, Haifa 31096,
Israel. E-mail: itai@pem-database.org.
Conflicts of Interest: By the WestJEM article submission
agreement, all authors are required to disclose all affiliations,
funding sources, and financial or management relationships that
could be perceived as potential sources of bias. The authors
disclosed none.
REFERENCES
1. Fordham LA, Chung CJ, Donnely LF. Imaging of congenital vascular and
lymphatic anomalies of the head and neck. Neuroimaging Clin North Am.
2000;10:117–136.
2. Sannoh S, Quezada E, Merer DM, et al. Cystic hygroma and potential
airway obstruction in a newborn: a case report and review of the literature.
Cases J. 2009;2:48.
3. Thompson DM, Kasperbauer JL. Congenital cystic hygroma involving the
larynx presenting as an airway emergency. J Natl Med Assoc.
1994;86:629–632.
4. Perkins JA, Manning SC, Tempero RM, et al. Lymphatic malformations:
review of current treatment. Otolaryngol Head Neck Surg. 2010;142:795–
803.
5. Luzzatto C, Midrio P, Tchaprassian Z, et al. Sclerosing treatment of
lymphangiomas with OK-432. Arch Dis Child. 2000;82:316–318.
6. Ishaq M, Minhas MR, Hamid M, et al. Management of compromised
airway due to unusual presentation of cystic hygroma. J Pak Med Assoc.
2006;56:135–137.
7. Barrand KG, Freeman NV. Massive infiltrating cystic hygroma of the neck
in infancy. Arch Dis Child. 1973;48:523–531.
8. Sheth S, Nussbaum AR, Hutchins GM, et al. Cystic hygromas in children:
sonographic-pathologic correlation. Radiology. 1987;162:821–824.
369 Western Journal of Emergency Medicine